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성균관 대학교 의과대학 G2 PBL
2007313075 손의영
Tutor : 최필조 교수님
Contents
Clinical
• Radiography for Knee pain
Radiology
• Rheumatoid Arthritis
• Osteoarthritis
Case Relevance
RADIOGRAPHY FOR KNEE PAIN
Radiography for Knee pain - STANDARD
• AP weight-bearing View
• Lateral View
• Merchant View
AP View
•
•
•
•
Antero-Posterior, Frontal View
OA 뿐 아니라 Knee pain 시 Routine 하게 찍는 편
임상소견과 이미지소견이 꼭 일치하는 것은 아님!!
Bipartite patella or Patella fracture 관찰 가능
25/M Normal
50/M Knee Pain
Dx. OA
출처 : 서울대병원 진방과
AP View
• Anatomy
Lateral View
Abnormaly high
Low
• Evaluate Loose body & Patella alta & baja
• Sup. & Inf. Osteophyte / Trochlear depth
• 단점 : Inter-observer reliability
Practical Orthopaedic Sports Medicine & Arthroscopy 1st Edition © 2007 Lippincott Williams & Wilkins
Lateral View
• Anatomy
Merchant View
Practical Orthopaedic Sports Medicine & Arthroscopy 1st Edition © 2007 Lippincott Williams & Wilkins
Merchant View
• Patello-Femoral Components 와 Patella 관찰
• Evaluate for Patella alignment
Practical Orthopaedic Sports Medicine & Arthroscopy 1st Edition © 2007 Lippincott Williams & Wilkins
Merchant View – Patella Alignment 평가하기
• From : Sulcus와 condyle 을 연결한 선을 그어서 이등분 선을 만든다
• To : Patella의 central ridge와 연결한 선  Med. OR Lat. ??
• Lat. 이 심할 수록 Alignment가 많이 망가졌다고 볼 수 있다.
Mild malalignment
Practical Orthopaedic Sports Medicine & Arthroscopy 1st Edition © 2007 Lippincott Williams & Wilkins
Patella Malalignment
<BEFORE>
<AFTER Surgery>
Copyright © 2010 UW-Eau Claire and the Board of Regents of the University of Wisconsin System
Patella Malalignment
<BEFORE>
<AFTER Surgery(Rt)>
Copyright © 2010 UW-Eau Claire and the Board of Regents of the University of Wisconsin System
Osteoarthritis, Rheumatoid Arthritis
RADIOLOGY
Degenerative Joint Disease – OA
• Imbalance between force across a joint and integrity of
articular cartilage matrix
• Systemic factors: age, obesity, occupation, activity,
inactivity, metabolic
• Local factors: trauma, malalignment, congenital or
acquired articular deformity, infection, RA, crystal
deposition disease
Osteoarthritis
• Stressed segment
(hip– superior, knee- medial compartment)
– Asymmetric joint space loss
– Subchondral sclerosis
– Subchondral cyst
하얗게 보이겠네
• Unstressed segment
– Marginal bony spur formation (osteophyte)
골극, 뼈돌기
• 초기에는 정상일 수 있다.
• 이미지상 중증도와 증상의 중증도가 일치하지는 않
는다.
• MRI, US 는 진단적 가치가 탁월하다? No!
Osteoarthritis
Rheumatoid Arthritis
• 40-50 세, M < F, RF (+)
• Synovial proliferation, Pannus formation
• Bilateral symmetric involvements
• Begin in small peripheral joints (hands, feet)
& C-spine, knees, hips, shoulder, elbows
• MCP, PIP & carpal joints, 4th & 5th MTP
Rheumatoid Arthritis
• Early changes
– Soft tissue swelling
• Synovial inflamation
– Periarticular osteopenia
• Increased vascularity
• Increased turn-over
– Marginal erosion
• Pannus formation
• Late changes
– Diffuse osteoporosis
– Symmetrical joint space
narrowing
• Cartilage destruction
– Subchondral cyst
• Subchondral bone destruction
– Subluxation
• Periarticular ligamentous
structure destruction
– Fibrous/bony ankylosis
Rheumatoid Arthritis
• Early changes
Soft tissue swelling
Periarticular osteopenia
Marginal bony erosion
Rheumatoid Arthritis
• Late changes
Subchondral cyst
Subluxation
Rheumatoid Arthritis
Symmetric joint space narrowing
CASE RELEVANCE
Case Relevance – X-ray
• Fig1. Standing AP view
Lat. : Unstressed
Med. : Stressed
Asymmetric joint space loss
Case Relevance – X-ray
• Fig2. Lateral View
Osteophyte??
Subchondral sclerosis
Case Relevance – X-ray
• Fig3. Rt. Weight-bearing View
More Stressed
Case Relevance – X-ray
• Fig4. Merchant View
왼쪽도 Mild malalignment
Reference
• Harrison's Principle on Internal Medicine, 17th ed.,
McGraw Hill Inc., 2008
• Practical Orthopaedic Sports Medicine & Arthroscopy
1st Edition © 2007 Lippincott Williams & Wilkins
• Copyright © 2010 UW-Eau Claire and the Board of
Regents of the University of Wisconsin System
• 윤영철 교수님 강의록 ‘관절염의 영상의학적 소견’